Tuesday 25 June 2019

Damning HIQA report a wake-up call for all involved in patient care

THE damning report into the deaths of five babies in similar circumstances in Portlaoise Hospital is the latest in a series of documents criticising HSE practices and presents the toughest challenge to date for Health Minister Leo Varadkar.

The HIQA report was ordered by former Health Minister James Reilly after questions were raised over patient safety in the Portlaoise Maternity Unit. While the report investigated five baby deaths, it found that up to eight babies had in fact died in similar circumstances and it highlighted failures in standards of care and severe underfunding.

The State Claims Agency had identified issues about the safety of pregnant women at the hospital as far back as 2007. Despite this, the report claimed that in 2014 patient safety was not even an agenda item at top level HSE management meetings, while multiple examples of poor oversight were also highlighted.

While risks had been clearly identified, serious questions need to be asked over exactly why there was a failure to act by HSE managers at national, regional and local level.

The HSE had threatened an injunction preventing the publication of the report, claiming that it amounted to reckless endangerment. In a statement of intent, HIQA rejected 102 responses to the draft report from the health executive.

The report made eight recommendations which will have wide implications in hospitals across the country and it puts an onus of responsibility on senior executives in the HSE to act decisively.

Most worrying though, is HIQA's concerns that it could not categorically say if services for patients at the midlands unit are safe today, stating that the safety of patients presenting with emergencies cannot be guaranteed.

There is now pressure on the HSE to reveal all maternity unit failures nationwide following a call from Patient Focus who had successfully campaigned for the report to be implemented.

As the HSE continues to investigate 49 serious incidents across the country's 19 maternity hospitals, the issue will remain at the top of the health department's agenda.

Whatever the outcome, the reality is that families have lost a baby in circumstances that may have been preventable. The babies suffered a lack of oxygen after foetal distress was not spotted or acted upon and the release of the HIQA report will revisit the hurt felt by each affected family.

It is clear that major action needs to be taken and Health Minister Leo Varadkar's acceptance of the report in full, as well as his statement that unviable services are to cease, is a major stepping stone to addressing the problems.

But it is the human cost that needs to be addressed first and foremost. Claims that mothers who lost children were reprimanded for crying for fear that they might upset other patients are simply unacceptable.

Some of the parents stated that they were handed the remains of their dead baby in a tin box. Empathy for grieving parents is paramount and the sorry episode is a major wake-up call for all involved in patient care.